Health, Lead Poisoning Funding, VNA etc
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MEMORANDUM
August31,2006
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Iowa Department of Public Health (IDPH) Childhood Lead Poisoning
Funding and Agreement with the Visiting Nurse Association (VNA) and the
Dubuque County Board of Health
Public Health Specialist Mary Rose Corrigan is recommending execution of the contract
with the Dubuque County Board of Health for continued funding of the Childhood Lead
Poisoning Prevention Program (CLPPP) and a renewed agreement with the Visiting
Nurse Association for services related to the CLPPP.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
MCVM/jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Mary Rose Corrigan, RN, Public Health Specialist
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MEMORANDUM
August29,2006
TO:
FROM:
Michael C. Van Milligen, City Manager
N\~
Mary Rose COrrigan~N, Public Health Specialist
SUBJECT:
Iowa Department of Public Health (IDPH) Childhood Lead Poisoning
Funding and Agreement with the Visiting Nurse Association (VNA) and
the Dubuque County Board of Health
INTRODUCTION
This memorandum provides information regarding a contract with the Dubuque County
Board of Health for continued funding of the Childhood Lead Poisoning Prevention
Program (CLPPP) and a renewed agreement with the VNA for services related to the
CLPPP.
BACKGROUND
In February 1994, the City Council approved a grant agreement authorizing the Health
and Housing Services Departments to contract with the Iowa Department of Public
Health for environmental follow-up and medical case management for children with
lead poisoning according to the Iowa Department of Public Health guidelines. The
original funding contract has been renewed annually. The latest contract ended June
30, 2006.
DISCUSSION
Since that time, the Iowa Department of Public Health has applied for ongoing funds
with the Centers for Disease Control and Prevention (CDC) to distribute to local
childhood lead poisoning prevention programs. The funds are distributed to local
Boards of Health in the State based on numbers of children in a community and the
incidence of lead poisoning.
The Iowa Department of Public Health contracts with local Boards of Health for
SUBCONTRACT AGREEMENT FOR CHILDHOOD LEAD POISONING
PREVENTION SERVICES
BETWEEN
DUBUQUE COUNTY BOARD OF HEALTH
AND
THE CITY OF DUBUQUE, IOWA
WHEREAS, the Dubuque County Board of Health (County Board), as
Contractor, has entered into an Agreement (the Agreement) with the Iowa
Department of Public Health to perform childhood lead poisoning prevention
services as set forth in the Agreement, a copy of which is attached hereto; and
WHEREAS, County Board desires to enter into a subcontract with the
City of Dubuque (City) to perform the services required by the Agreement and
City desires to provide such services through its Health Services Department.
NOW, THEREFORE, IT IS AGREED BY AND BETWEEN THE PARTIES
AS FOLLOWS:
1. City shall perform all of the services required of the Contractor in the
Agreement.
2. County Board shall pay City for its services in the same manner as
County Board as Contractor will be paid for its services under the Agreement.
,2006.
Nick Goo ann
Dubuque County Board of Health
Michael C. Van Milligen
City Manager
,
,
AGREEMENT BETWEEN THE CITY OF DUBUQUE, IOWA,
AND THE VISITING NURSE ASSOCIATION
FOR THE CHILDHOOD LEAD POISONING PREVENTION PROGRAM (CLPPP)
Now on this 1 st day of July 2006, it is agreed by and between the City of Dubuque,
Iowa, (City) and the Dubuque Visiting Nurse Association (VNA) as follow:
A. TERM. The term of this Agreement shall be from the 1 st day of July 2006,
through the 30th day of June 2007.
B. CITY'S RESPONSIBILITIES. City agrees that it will provide the following
services for the CLPPP:
1. Submit quarterly reports and other reporting requirements as requested to
the Iowa Department of Public Health (IDPH) and the Centers for Disease
Control and Prevention. (CDC).
2. Provide for environmental investigations and environmental case
management for lead abatement\lead hazard reduction in housing units in
the city of Dubuque, Iowa, and Dubuque County.
3. Provide compensation to the VNA during the term of this Agreement not
to exceed $9,000.00 for the performances of VNA's responsibilities as set
forth herein.
4. Oversee and direct medical case management and educational activities
through verbal and written direction.
C. VNA'S RESPONSIBILITIES. VNA agrees to provide the following services for
CLPPP during the term of this Agreement for the agreed compensation:
1. Provide written quarterly reports on lead-related activities utilizing the Iowa
Quarterly Report Narrative Outline.
2. Provide computer documentation of medical case management and
related activities into City's lead database system, STELLAR.
3. Provide blood lead screening and medical case management for follow-up
testing for children in the city of Dubuque following the recommendations
of the IDPH and the City of Dubuque Health Services Department.
4. Assist City with providing public education, lead coalition development and
activities, and outreach to the City of Dubuque residents about childhood
lead poisoning.
5. Conduct home visits as needed to families\residents in order to provide
medical case management services.
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6. Provide education and medical case management of children with
confirmed blood lead levels greater than or equal to 15 jJg\dL. Medical
case management includes:
. assurance that children are being screened\retested for lead and
case managed according to Iowa Department of Public Health
requirements;
. assurance that children and parents receive nutritional counseling
and educational materials;
. educate parents and families about major sources of lead and how to
prevent poisoning;
. assistance in interpreting blood lead levels;
. refer all children with confirmed blood lead levels greater to or equal
to 20 jJg\dL to Keystone Area Education Agency for appropriate
developmental testing, evaluation and assessment; and
. provide information about lead testing and follow-up, available
services, and resources for lead- poisoned children.
7. Provide information about lead poisoning and available services to local
pediatric health care providers.
8. Participate with City in securing additional funding for childhood lead
poisoning prevention activities.
9. Provide monthly work activity reports and invoices to the City Health
Services Department outlining services performed, by the 7th day of the
month following the previous month.
10. Work towards achieving the program performance standards in conjunction
with the City's CLPPP, as outlined in the City's IDPH contract, Exhibit III.
D. INSURANCE. VNA agrees to provide insurance as set forth in the attached
Insurance Schedule.
E. INDEMNIFICATION. City agrees to save, defend, indemnify and hold harmless
VNA from and against any and all claims which may be made against VNA arising out of
this Agreement which are the result of the sole negligence of City, its officers, agents or
employees. VNA agrees to defend, hold harmless and indemnify City from and against
any and all claims which may be made against City arising out of this Agreement which
are the sole negligence of VNA, its officers, employees or agents.
F. TERMINATION. Either party may terminate this Agreement by giving sixty (60)
days written notice to the other party.
2
CITY OF DUBUQUE, IOWA
VISITING NURSE ASSOCIATION
BY:
BY:
Nan Colin
Administrative Director
Michael C. Van Milligen
City Manager
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INSURANCE SCHEDULE C
INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE
CITY OF DUBUQUE
1. All policies of insurance required hereunder shall be with an insurer authorized to do business in Iowa.
All insurers shall have a rating of A better in the current A.M. Best Rating Guide.
2. All policies of insurance shall be endorsed to provide a thirty (30) day advance notice of cancellation to
the City of Dubuque, except for 10 day notice for non-payment, if cancellation is prior to the expiration
date. This endorsement supersedes the standard cancellation statement on the Certificate of
Insurance.
3. shall furnish a signed Certificate of Insurance to the City of Dubuque, Iowa
for the coverage required in Paragraph 6 below. Such Certificates shall include copies of the following
endorsements:
a) Commercial General Liability policy is primary and non-contributing.
b) Commercial General Liability additional insured endorsement.
c) Governmental Immunities Endorsement.
shall also be required to provide Certificates of Insurance of all
subcontractors and all sub-sub contractors who perform work or services pursuant to the provisions of
this contract. Said certificates shall meet the same insurance requirements as required of
4. Each certificate shall be submitted to the contracting department of the City of Dubuque.
5. Failure to provide minimum coverage shall not be deemed a waiver of these requirements by the City
of Dubuque. Failure to obtain or maintain the required insurance shall be considered a material
breach of this agreement.
6. Contractor shall be required to carry the following minimum coverage/limits or greater if required by
law or other legai agreement:
a) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit
Products-Completed Operations Aggregate Limit
Personal and Advertising Injury Limit
Each Occurrence Limit
Fire Damage limit (anyone occurrence)
Medical Payments
$2,000,000
$1,000,000
$1,000,000
$1,000,000
$ 50,000
$ 5,000
INSURANCE SCHEDULE C (Continued)
INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES TO THE
CITY OF DUBUQUE
This coverage shall be written on an occurrence form, not claims made form. All deviations or
exclusions from the standard ISO commercial general liability form CG 0001 or Business owners BP
0002 shall be clearly identified. Form CG 25 04 03 97 'Designated Location (s) General Aggregate
Limit' shall be included.
Governmental Immunity endorsement identical or equivalent to form attached.
Additional Insured Requirement:
The City of Dubuque, including all its elected and appointed officials, all its employees and
volunteers, all its boards, commissions and/or authorities and their board members, employees
4
,
. ,
and volunteers shall be named as an additional insured on General Liability including "ongoing
operations" coverage equivalent to ISO CG 20100704.
b) Automobile $1,000.000 combined sinale limit.
c) WORKERS COMPENSATION & EMPLOYERS LIABILITY
Statutory for Coverage A
Employers Liability:
Each Accident
Each Employee Disease
Policy Limit Disease
$ 100,000
$ 100,000
$ 500,000
$1,000,000
d) PROFESSIONAL LIABILITY
e) UMBRELLA/EXCESS LIABILITY'
'Coverage and/or limit of liability to be determined on a case-by-case basis by Finance Director.
Completion Checklist
D Certificate of Liability Insurance (2 pages)
D Designated Location(s) General Aggregate Limit CG 25 04 03 97
D Additional Insured CG 20100704
D Governmental Immunities Endorsement
500
June 2005
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CITY OF DUBUQUE, IOWA
GOVERNMENTAL IMMUNITIES ENDORSEMENT
1. Nonwaiver of Governmentallmmunitv. The insurance carrier expressly agrees and
states that the purchase of this policy and the including of the City of Dubuque, Iowa
as an Additional Insured does not waive any of the defenses of governmental
immunity available to the City of Dubuque, Iowa under Code of Iowa Section 670.4
as it is now exists and as it may be amended from time to time.
2. Claims Coveraae. The insurance carrier further agrees that this policy of insurance
shall cover only those claims not subject to the defense of governmental immunity
under the Code of Iowa Section 670.4 as it now exists and as it may be amended
from time to time. Those claims not subject to Code of Iowa Section 670.4 shall be
covered by the terms and conditions of this insurance policy.
3. Assertion of Government Immunitv. The City of Dubuque, Iowa shall be responsible
for asserting any defense of governmental immunity, and may do so at any time and
shall do so upon the timely written request of the insurance carrier.
4. Non-Denial of Coveraae. The insurance carrier shall not deny coverage under this
policy and the insurance carrier shall not deny any of the rights and benefits
accruing to the City of Dubuque, Iowa under this policy for reasons of governmental
immunity unless and until a court of competent jurisdiction has ruled in favor of the
defense(s) of governmental immunity asserted by the City of Dubuque, Iowa.
No Other Chanae in Policv. The above preservation of governmental immunities shall
not otherwise change or alter the coverage available under the policy.
SPECIMEN
60f7
June 2005
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Thomas J. Vilsack
Governor
1
Iowa Department of Public Health
Sally j. Pederson
Lt. Governor
CONTRACT #: 5887LP05
PROJECT TITLE: Childhood Lead Poisoning
Prevention Program
FUNDING SOURCE OF IDPH:
FEDERAL: $11,196 -- 68.43%
STATE: $5,166 -- 31.57%
OTHER: $0 -- 0.00%
FEDERAL CATALOG#: 93.197
MATCH REQUIRED: YESD NO[8J NAD
MAlL REPORTS TO:
Rita Gergely, Chief
Bureau of Lead Poisoning Prevention
Division of Environmental Health
Iowa Department of Public Health
321 East 12'h Street
Lucas State Office Building
Des Moines, 1A 50319-0075
Mary Mincer Hansen, R.N., Ph.D.
Director
PROJECT PERIOD: July 1,2006 to June 30, 2007
CONTRACT PERIOD: July I 2006 to June 30 2007
CONTRACT AMOUNT: $16,362
FEDERAL TAX ID#: 426004597
CONTRACTOR:
Dubuque County Bnard of Health
c/o City of Dubuque Health Services Department
City Hall Annex
1300 Main Street
Dubuque 1A 52001
CONTRACT ADMINISTRATOR INFORMATION
NAME: Mary Rose Corrigan
PHONE: 563-589-4181 FAX: 563-589-4299
E-MAIL: health@cityofdubuque.org
The CONTRACTOR agrees to perform the work and to provide the services described in the Special
conditions for the consideration stated herein. The duties, rights, and obligations of the parties to ibis
contract shall be governed by the Contract Documents, which include the Special Conditions, General
Conditions, Request for Proposal and Application.
The CONTRACTOR has reviewed and agrees to the General Conditions etlective January I, 2006, as
posted on the Department's web at www.idoh.state.ia.us (click on Availability of Funds Link) or as
available by contacting Rita Gergely at 515/242-6340.
The parties hereto have executed ibis contract on the day and year last specified below.
For and on behalf of the Department: For and on behalf of the Contractor:
~ ~
Tom Newton, Director, Division of Environmental Health Nick Goodman, Chair, Board of Health
Date Date
Promoting and protecttng the health of lCM'ans
Lucas State Office Building, 321 E. 121h Street, Des Moines, lA 50319-0075 . 515-281-7689. www.idph.state.ia.u5
DEAF RELAY (Hearing or Speech Impaired) 711 or I 800-735-2942
SPECIAL CONDITIONS FOR CONTRACT #5887LP05
ARTICLE I - IDENTIFICATION OF PARTIES.
This contract is entered into by and between the Iowa Department of Public Health (hereinafter referred to as
the DEPARTMENT) and the CONTRACTOR, as identified on the contract face sheet.
ARTICLE II - IDENTIFICATION OF AUTHORIZED STATE OFFICIAL:
Tom Newton, Director, Division of Environmental Health, is the Authorized State Official for this contract.
Any changes in the terms, conditions, or amounts specified in this contract must be approved by the
Authorized State Official. Negotiations concerning this contract should be referred to Rita Gergely, Chief,
Bureau of Lead Poisoning Prevention, 515/242-6340
ARTICLE III - DESIGNATION OF CONTRACT ADMINISTRATOR AND KEY
PERSONNEL
Mary Rose Corrigan has been designated by the CONTRACTOR to act as the Contract Administrator. This
individual is responsible for financial and administrative matters ofthis contract. Negotiations concerning
this contract should be referred to Mary Rose Corrigan; telephone 563-589-4181.
The primary agency subcontracted to carry out the responsibilities of the contract is: City of Dubuque Health
Services Department. The following individual(s) shall be considered key personnel:
Title
A enc Director
Contract Administrator
Pro am Administrator
Finance Mana er
Data En Clerk
Nurse
Certified Elevated Blood Lead (EBL) Inspector/Risk Assessor
ARTICLE IV - STATEMENT OF CONTRACT PURPOSE
The purpose of this contract is to provide funds for the CONTRACTOR to conduct childhood lead poisoning
prevention activities as specified in Article V, Description of Work and Services.
ARTICLE V - DESCRIPTION OF WORK AND SERVICES:
The CONTRACTOR shall conduct childhood lead poisoning prevention services as specified in this article.
DEFINITIONS
"Blood lead testing" means taking a capillary or venous sample of blood and sending it to a laboratory to
detennine lhe level oflead in lhe blood.
"Capillary" means a blood sample taken from lhe finger or heel for lead analysis.
"Care coordination" means lhe process oflinking lhe service system to the recipient and/or family, and
coordination of lhe various elements in order to achieve a successful outcome.
"CDC" means the Centers for Disease Control and Prevention.
"Certified elevated blood lead (EBL) inspection agency" means an agency that has met lhe requirements of
641-70.5(135) and lhat has been certified by the department.
"Certified elevated blood lead (EBL) inspector/risk assessor" means a person who has met lhe requirements
of641-70.5(135) for certification or interim certification and who has been certified by lhe department.
"Chelation" means lhe administration of medication lhat binds lead so lhat it can be removed from lhe body.
"Child health contractor" means an agency lhat has a contract wilh lhe Iowa Department of Public Heallh
for lhe Title V Child Health program.
"Childhood Lead Poisoning Prevention Program (CLPPP) service area" means the geographic area for
which lhe CLPPP has agreed to provide CLPPP services.
"CLPPP" means childhood lead poisoning prevention program.
"Complete medical evaluation" means a history, physical examination, and testing for iron status as
descnbed in Chapter 7 of Preventing Lead Poisoning in Young Children, CDC, October 1991.
"Data management" means all actions taken by lhe CONTRACTOR to manage blood lead data and case
management data. This includes, but is not limited to, entering blood lead test results for all individuals
under lhe age of16 years in lhe CLPPP service area who receive blood lead testing from lhe CLPPP or any
olher provider in lhe STELLAR database, documenting all case management actions such as contact wilh lhe
family or provider, EBL inspection, lead hazard remediation, home nursing or outreach visits, nutrition
evaluations, and developmental assessments in lhe STELLAR database, and providing all STELLAR reports
required by lhis contract.
"Developmental testing" means testing done by lhe local Area Education Agency to determine whelher a
child is developmentally delayed
"Education and outreach" means seeking out and providing information regarding childhood lead poisoning
to members of populations who are at high risk for lead poisoning and lhose who work for agencies lhat
provide service to lhese high-risk populations; members of lhe general public, including homeowners,
landlords, Realtors, and members of community organizations, and health professionals and para-
professionals, including physicians, nurses, and laboratory technicians.
"Elevated blood lead (EBL) child" means any child who has had one venous blood lead level greater than or
equal to 20 micrograms per deciliter (flgldL) or at least two venous blood lead levels of 15 to 19 flgldL.
"Elevated blood lead (EBL) inspection" means an inspection to determine the sources oflead exposure for
an elevated blood lead (EBL) child and the provision within ten working days of a written report explaining
the results of the investigation to the owner and occupant of the residential dwelling or child-occupied
facility being inspected and to the parents of the elevated blood lead (EBL) child
"Elevated blood lead (EBL) inspection agency" means an agency that employs or contracts with individuals
who perform elevated blood lead (EBL) inspections. Elevated blood lead (EBL) inspection agencies may
also employ or contract with individuals who perform other lead-based paint activities.
"Environmental case management" means providing elevated blood lead (EBL) inspections in all dwellings
associated with an EBL child and assuring that lead hazards identified at these dwellings.
"Follow-up blood lead testing" means blood lead testing that is conducted after a child has had at least one
capillary or venous blood lead level greater than or equal to 10 flgldL.
"Home nursing or outreach visit" means a home visit conducted by a nurse or social worker to provide
information to the caregiver of a lead-poisoned child regarding the health effects of lead poisoning, the
importance of good housekeeping and nutrition, and the importance of follow-up blood lead testing and to
assess the overall situation of the child and family to determine whether the child and/or family should be
referred for additional services.
"Lead-based paint hazard" means hazardous lead-based paint, a dust-lead hazard, or a soil-lead hazard as
defined in 64l-Chapter 70.
"Lead hazard remediation" means the control of lead hazards identified in the EBL inspection through
interim controls, renovation and remodeling, or lead abatement.
"Local board of health "means a COlUlty, district, or city board of health.
"Local coalition" meaus a group convened by the CONTRACTOR to address the issue of childhood lead
poisoning in the CLPPP service area. The local coalition should be composed of physicians, nurses, housing
officials, parents, contractors, and representatives of neighborhoods where homes are being renovated
"Medical case management" meaus all services necessary to evaluate the health and development of a child
with a blood lead level greater than or equal to 10 flgldL and to treat any conditions identified in the
evaluation. Medical case management includes, but it not limited to, follow-up blood lead testing, medical
evaluation, home nursing or outreach visits, chelation, nutrition evaluation, developmental assessment, and
care coordination.
"Nutrition evaluation" meaus an evaluation conducted by a dietician to determine whether a child is
receiving a well-balanced and age-appropriate diet, with particular attention to the child intake of Vitamin C,
iron, and calcium.
"Quarterly narrative report" means a report of the contractor's childhood lead poisoning prevention
activities for the quarter that is developed according to guidelines provided by the department and is
provided to the department by the deadlines given in Article Vll.
"Referral" means to direct the family of a lead-poisoned to a service for the family or the child and to
follow-up to assure that the family actually received the service.
"STEUAR" means the Systematic Tracking of Elevated Lead Levels and Remediation database, which is
provided by CDC at no charge.
"STELLAR Lab Batch" means the procedure in STELLAR that processes blood lead tests and sets dates for
follow-up blood lead tests, opens medical cases, and opens environmental cases.
"STELLAR quarterly report" means the procedure in STELLAR that compiles the contractor's activities for
the quarter into a data file that is submitted to the department electronically by the deadlines given in Article
VII.
"Venous" means a blood sample taken from a vein in the arm for lead analysis.
CLPPP SERVICE AREA
The CLPPP service area is Dubuque County.
REOUIRED SERVICES
The CONTRACTOR is responsible for blood lead testing, data management, environmental case
management, medical case management, education and outreach, and the local coalition within its service
area. The CONTRACTOR shall develop written protocols to descnbe how each of these services will be
provided The CONTRACTOR may use templates provided by the department to develop these protocols.
BLOOD LEAD TESTING
The CONTRACTOR shall assure that the State of Iowa Plan for Childhood Blood Lead Testing (January
2004) is implemented within the CLPPP service area. The CONTRACTOR shall assure that medical
providers conduct blood lead testing according to this plan. The CONTRACTOR may also conduct blood
lead testing.
The CONTRACTOR shall provide a written notice of the results of blood lead testing to the caregivers of all
children tested by the CONTRACTOR. The written notice shall include information regarding the meaning
of the blood lead test result and the date when the child should be tested again.
The CONTRACTOR shall provide a written notice of the results of blood lead testing to the caregivers of all
children in the CLPPP service area who have blood lead levels greater than or equal to 10 llgldL, regardless
of whether the CONTRACTOR did the testing. The written notice shall include information regarding the
meaning of the blood lead test result, actions that the parents can take to reduce the child's blood lead level,
and the date when the child should be tested again.
DATA MANAGEMENT
The CONTRACTOR shall conduct data management as specified in this contract.
The CONTRACTOR shall notifY the department within 10 working days of assigning STELLAR data entry
duties to a new staff person. The CONTRACTOR shall assure the department that new data entry staffhas
received appropriate training or work with the department to assure that new data entry staff receives
appropriate training.
The CONTRACTOR shall install STELLAR on a computer network consisting of at least two computers
that are linked to the same server. The CONTRACTOR shall allow the DEPARTMENT and other agencies
providing medical and environmental case management oflead-poisoned children in the CLPPP service area
to access the main STELLAR database via the software, PC Anywhere, or another software package
approved in advance by the DEPARTMENT. This software shall be installed on a computer that is
continuously available for the DEPARTMENT and other agencies for access. The CONTRACTOR may
request that the DEPARTMENT waive the requirement that STELLAR be installed on a network and that a
computer be continuously available for the DEPARTMENT and other agencies to access. The
CONTRACTOR shall make this request in writing. The DEPARTMENT will approve or deny these
requests on a case-by-case basis.
The CONTRACTOR shall enter the results of blood lead testing for all individuals under the age of 16 years
in the CLPPP service area who receive blood lead testing from the CLPPP or any other provider in the
STELLAR database. The CONTRACTOR shall document all case management actions taken by the
CONTRACTOR such as contact with the family or provider, EBL inspection, lead hazard remediation, home
nursing or outreach visits, nutrition evaluations, and developmental assessments in the STELLAR database
and shall assure that all CLPPP subcontractors also document all case management actions that they taken in
STELLAR. The CONTRACTOR shall enter blood lead test results and case management actions into
STELLAR on at least a weekly basis. The CONTRACTOR shall run STELLAR Lab Batch at least every
two weeks and shall forward case information to other agencies providing medical and environmental case
management in the CLPPP service area at least every two weeks.
The CONTRACTOR shall provide all STELLAR reports by the deadlines given in this contract.
The DEPARTMENT will periodically review the CONTRACTOR STELLAR database for errors and notify
the CONTRACTOR of errors that must be corrected. The CONTRACTOR shall correct the errors by the
date specified in the notification and shall implement quality control measures to prevent data entry errors.
FILING SYSTEM AND RETENTION OF RECORDS
Paper copies of all blood lead test results entered into STELLAR shall be filed alphabetically by the name of
the child and shall be retained by the CONTRACTOR until one (1) year after the child attains the age of
majority. Paper copies of blood lead test results shall be maintained by the primary agency subcontracted to
carry out the responsibilities of the contract. Paper copies of blood lead test results will be transferred to the
DEPARTMENT if the contract is terruinated. The CONTRACTOR may request that the DEPARTMENT
waive the requirement that the CONTRACTOR file all blood lead test results alphabetically by the name of
the child The CONTRACTOR shall make this request in writing. The DEPARTMENT will approve or
deny these requests on a case-by-case basis.
ENVIRONMENTAL CASE MANAGEMENT
The CONTRACTOR shall maintain certification of individual inspectors as elevated blood lead (EBL)
inspector/risk assessors and agency certification as an elevated blood lead level (EBL) inspection agency.
The CONTRACTOR and the certified individuals shall comply with the provisions ofIowa Administrative
Code 641-70.6(3). The CONTRACTOR shall be enrolled as a Medicaid provider for EBL inspection
services and shall recover reimbursement from Medicaid for EBL inspections and use the reimbursement as
program income.
The CONTRACTOR shall conduct elevated blood lead (EBL) inspections for any child under the age of six
years who has had one venous blood lead level greater than or equal to 20 J.Ig/dL or at least two venous blood
lead levels of 15 to 19 J.Ig/dL. EBL inspections shall be conducted for all addresses associated with the child
and for all addresses that the child moves to after the case is initially reported until the child has had one
blood lead level less than 10 l1g1dL or three blood lead levels less than 15 l1g1dL. EBL inspections shall be
conducted within the following times:
. Two venous blood lead levels of 15 to 19 l1g1dL - within 4 weeks after the report.
. Venous blood lead level of20 to 44 l1g1dL - within 2 weeks after the report
. Venous blood lead level of 45 to 69 l1g1dL - within 1 week after the report
. Venous blood lead level greater than or equal to 70 l1g1dL - within 2 days after the report.
The CONTRACTOR shall document in STELLAR the reason why the CONTRACTOR was unable to
complete any inspection required by this contract.
The CONTRACTOR shall contact the occupants and/or owners of dwellings where lead hazards have been
identified within 30 days of the initial inspection to check their progress towards making the dwelling lead-
safe. The CONTRACTOR shall contact the current owners of all dwellings where lead hazards were
identified, but lead hazard remediation has not been completed, at least once every six months until lead
hazard remediation is completed. The CONTRACTOR shall continue to follow up on all of these dwellings
until lead hazard remediation is completed, regardless of whether the dwellings are owner-occupied or rental
and regardless of changes in ownership. The CONTRACTOR shall not close an address associated with a
lead-poisoned child where lead hazards have been identified unless the lead hazard remediation has been
completed or unless permission is obtained in advance from the DEPARTMENT.
The CONTRACTOR shall, to the extent possible, assist families who have lead-poisoned children in
locating resources for lead hazard remediation and/or alternative housing.
Beginning September 1,2006, the CONTRACTOR must conduct clearance testing according to Iowa
Administrative Code Chapter 641-70, Lead Professional Certification, before verifYing that lead hazard
remediation has been completed in a home associated with a lead-poisoned child.
To be eligible for continued funding beginning July 1,2007, each county in the service area must have
adopted a local board of health regulation or a local board of supervisors ordinance that is at least as
protective as Iowa Administrative Code Chapter 641--68, Control of Lead-Based Paint Hazards.
MEDICAL CASE MANAGEMENT
The CONTRACTOR shall conduct medical case management as specified in this contract.
The CONTRACTOR shall be enrolled as a Medicaid provider for services that can be reimbursed by
Medicaid and shall recover reimbursement from Medicaid for medical case management services and use the
reimbursement as program income.
Follow-up blood lead testinl!
The CONTRACTOR shall assure that providers in the CLPPP service that conduct blood lead testing
provide follow-up blood lead testing for children under the age of six years within the timelines listed below.
The CONTRACTOR may provide this follow-up blood lead testing.
Confirmatory venous blood lead testinl!
. Capillary blood lead level of 15 to 19 l1g1dL - within 4 weeks after the report.
. Capillary blood lead level of20 to 44 I1g/dL - within 1 week after the report
. Capillary blood lead level of 45 to 69 IlgldL - within 48 hours after the report
. Capillary blood lead level greater than or equal to 70 IlgldL - immediately.
Follow-UD testing after an elevated blood lead level for a child who has not been chelated
. Capillary or venous blood lead level of 10 to 14 IlgldL - within 3 months. After two levels less than
10 IlgldL or three levels less than 15 IlgldL, testing should follow the routine testing schedule for
high-risk children.
. Venous blood lead level of 15 to 19 IlgldL - within 3 months.
. Venous blood lead level of 20 to 44 IlgldL - within 4 to 6 weeks.
. Venous blood lead level greater than or equal to 45 IlgldL - immediately
Follow-up testing for a child who has been chelated
. At the end of chelation.
. Depending on the blood lead level, 7 to 21 days after the end of chelation. The results of this test will
determine the need for additional chelation and the schedule for additional blood lead testing.
Medical evaluations
The CONTRACTOR shall assure that providers in the CLPPP provide conduct medical evaluations for
children under the age of six years within the following timelines:
. Venous blood lead level of20 to 44 IlgldL - Refer within 48 hours after the report so that the service
is received within 5 days.
. Venous blood lead level of 45 to 69 IlgldL - Refer within 24 hours atler the report so that the service
is received within 48 hours.
. Venous blood lead level greater than or equal to 70 IlgldL - Refer for emergency medical evaluation.
Home nursing or outreach visits
The CONTRACTOR shall provide home nursing or outreach visits for children under the age of six years
according to the following timelines:
. Venous blood lead level of 15 to 19 IlgldL - within 4 weeks after the report.
. Venous blood lead level of 20 to 44 IlgldL - within 2 weeks after the report
. Venous blood lead level of 45 to 69 IlgldL - within 1 week after the report
. Venous blood lead level greater than or equal to 70 IlgldL - within 2 days after the report.
Chelation
The CONTRACTOR shall assure that children with two venous blood lead levels greater than or equal to 45
IlgldL receive chelation.
Nutrition evaluation
The CONTRACTOR shall assure that children under the age of six years with a venous blood lead level
greater than or equal to 15 IlgldL receive a nutrition evaluation according to the following timelines:
. Venous blood lead level of 15 to 19 Ilg/dL - Refer within 4 weeks after the report so that the service
is received within 6 weeks.
. Venous blood lead level of 20 to 44 IlgldL - Refer within 2 weeks after the report so that the service
is received within 4 weeks.
. Venous blood lead level of 45 to 691lgldL - Refer within 1 week after the report so that the service is
received within 2 weeks.
. Venous blood lead level greater than or equal to 70 IlgldL - Refer within 2 days after the report so
that the service is received with 1 week.
The CONTRACTOR shall contact the DEPARTMENT for assistance if access to a dietician cannot be
assured for children under the age of six years with a venous blood lead level greater than or equal to 15
IlgldL
Develoomental assessment
The CONTRACTOR shall assure that children under the age of six years with a venous blood lead level
greater than or equal to 20 IlgldL receive a developmental assessment according to the following timelines:
. Venous blood lead level of 20 to 44 IlgldL - Refer within 2 weeks after the report.
. Venous blood lead level of 45 to 69 IlgldL ~ Refer within 1 week after the report
. Venous blood lead level greater than or equal to 70 IlgldL - Refer within 2 days after the report.
Care coordination
The CONTRACTOR shall provide care coordination or refer the family to the local child health contractor
for this service.
Medical Case Closure Guidelines
Medical cases shall be closed only in the following circumstances:
1. A child has had two consecutive blood lead levels less than 10 IlgldL or three consecutive blood lead
levels less than 15 IlgldL after the initial elevated blood lead level.
2. A child has had a capillary false positive blood lead level; that is, a capillary or venous blood lead
level less than 10 IlgldL immediately after a single capillary blood lead level greater than or equal to
151lgldL
3. A child has reached the age of six years and has a blood lead level less than 20 IlgldL.
4. A child has moved out of the CLPPP service area The CONTRACTOR shall immediately notifY the
appropriate local CLPPP agency in the area to which the child has moved and provide copies of all
environmental and medical case management records to the awropriate local CLPPP agency.
CHILDREN OVER THE AGE OF SIX YEARS
The CONTRACTOR shall contact the department for specific case management guidelines for a child over
the age of six years who has a venous blood lead level greater than or equal to 20 IlgldL.
EDUCATION AND OUTREACH
The CONTRACTOR shall provide education and outreach regarding childhood poisoning in the CLPPP
service area
LOCAL COALITION
The CONTRACTOR shall establish a local coalition for the CLPPP service area. The coalition may be a
subgroup/work group of a larger wnbrella coalition. However, participation in an wnbrella coalition does
not meet this requirement unless a specific subgroup has been formed to deal with lead poisoning prevention
in the community. The coalition shall include citizens who are not part of agency (Health, Housing, Human
Services, etc.) staff that participate in the CLPPP. The CONTRACTOR shall devote at least 8 hours of staff
time to the establishment and maintenance of the coalition.
ARTICLE VI - PERFORMANCE MEASURE
Not applicable.
ARTICLE VII - REPORTS
The CONTRACTOR shall prepare and submit the following reports to the DEPARTMENT on forms and/or
in the format approved by the DEPARTMENT:
Reoort
Claim Voucher
Number
1 original
Date Due
Within 45 days of mouth of expenditure
Expenditure Report
1 original
Within 45 days of month of expenditure
Quarterly Narrative Report
1 Electronic
10-25-2006
1-25-2007
4-25-2007
7-25-2007
STELLAR Quarterly Report
1 Electronic
10-25-2006
1-25-2007
4-25-2007
7-25-2007
ARTICLE VIII- BUDGET:
The total approved budget for this contract period is detailed in Exhibit I. Services will be reimbursed at a
flat fee as specified on Exhibit I up to the amount ofthe contract.
The CONTRACTOR may change the number of any deliverable that the DEPARTMENT will reimburse
under this contract only after filing a written request for the revision and receiving written approval for this
change.
ARTICLE IX: PAYMENTS
1. The DEPARTMENT provides contractual payments on the basis of reimbursement of actual
expenses in accordance with Iowa Code 8A.514.
2. The DEPARTMENT will uot reimburse travel amounts in excess of limits established by Iowa
Department of Revenue and Finance.
. '
a. Instate maximwn allowable amounts for food are $8.00fbreakfast, $9.00/lunch and
$18.00/dinner; lodging maximwn $75 plus taxes per night and mileage maximwn of $.34 per
mile.
b. Out of state maximwn allowable amounts for meals are available upon request. There is no
restriction on airfare or lodging but the incurred expenditures are to be reasonable.
3. Final payment may be withheld until all contractually required reports have been received and
accepted by the DEPARTMENT. At the end of the contract period, unobligated contract amount
funds shall revert to the DEPARTMENT.
ARTICLE X - LOCAL BOARD OF HEALTH LINKAGE:
1. As a condition of the contract, the CONTRACTOR shall assure linkage with the local board of health
in each county where services are provided The CONTRACTOR will assure that the local board of
health has been actively engaged in planning for, and evaluation of, services. It will also maintain
effective linkages with the local board of health, including timely and effective communications and
ongoing collaboration.
2. All work plan revisions must be approved by the DEPARTMENT prior to implementation.
ARTICLE XI - ADDITIONAL CONDITIONS
1. Funds must be made available to reimburse subcontractor expenses no later than August 1, 2006.
2. Funds may not be spent for indirect costs, chelation or other medical treatment of lead poisoning, or
lead hazard remediation. Funds may not be spent for blood lead analysis unless this service is listed
as a line item on the expenditure report. Per Iowa Code 135.103, if blood lead analysis is listed as a
line item on the expenditure report, the analysis must be conducted by a public health laboratory.
3. On January 1,2007, April 1,2007, and June 1,2007, the DEPARTMENT may amend the contract to
revert funds that are estimated to be unused to the DEPARTMENT and to reallocate the funds to
contractors with demonstrated special needs for childhood lead poisoning prevention services.
4. Final payments may be withheld if the agency or personnel employed by the agency are not in
compliance with Iowa Administrative Code Chapter 64 I -70, Lead Professional Certification.
5. The CONTRACTOR must check Internet e-mail at least once each week for lead poisoning
prevention updates sent out by the DEPARTMENT.
6. XRF analyzers that were originally purchased, in part or in whole, with Iowa Department of Public
Health grant funds, are to be shared with other elevated blood lead (EBL) inspector/risk assessors that
have a contract with the Childhood Lead Poisoning Prevention program. This sharing is to be at no
cost other than their travel to pick up and deliver the machine. Programs are strongly encouraged to
also share the XRF analyzers with government and private, non-profit housing agencies that employ
appropriately certified inspector/risk assessors. Any fees received for sharing the machine with
government and private, non-profit housing agencies are considered program income that shall be
retwned to the lead program and used to enhance lead program efforts.
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